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Essential fatty acids: The joint inflammation that accompanies osteoarthritis is regulated in large part by essential fatty acids. The kinds of fat in the diet, particu-larly the ratio of omega-3 to omega-6 fatty acids, can either promote or hinder produc-tion of prostaglandins, the messenger molecules that influence pain and inflammation. The omega-3 fatty acids alpba-linoleic acid (ALA) and eicosapentaenoic acid (EPA) both decrease the production of pro-inflam-matory prostaglandins, while gamma-linole-ic acid (GLA) helps produce beneficial prostaglandins. Conversely, animal products and saturated fats in the diet ultimately pro-duce arachidonic acid, a prostaglandin pre-cursor that prompts inflammation and pain.

The omega-3 fatty acids are also touted by Harvard Medical School in Cambridge, Mass., as an effective tool for lessening the symptoms of rheumatoid arthritis.8.7

An ideal omega-3 to omega-6 ratio ranges from 1:1 to 1:2. Most Americans, however, eat a diet that contains a ratio closer to 1:10 to 1:25. Eating more cold-water, fatty ocean fish such mackerel, herring, salmon, sardines and tuna remedies low EPA levels. GLA is present in evening primrose oil, black currant oil and borage seed oil, while green vegetables are a good source of ALA.

Bioflavonoids: The plant-derived bioflavonoids, often found in combination with vitamin C, have strong antioxidant and anti-inflammatory properties and appear to modulate key enzyme reactions in the inflammatory cascade.8 Bioflavonoids also affect the structure of collagen-the strong fibrous protein found in all connective tissue including cartilage-by protecting it from free radical destruction and cross-linking directly with the collagen fibers.9

Bioflavonoids are found in green tea, citrus fruit, berries, onions and pitted fruits. Supplemental forms include rutin, quercetin, hesperidin, ginkgo (Ginko biloba), milk thistle (Silyburn inai) and proanthocyanidins.

Glucosamine and chondroitin:

Glucosamine and chondroitin sulfates are partners in the process of regenerating cartilage, which reduces the pain and inflammation of osteoarthritis.

Glucosamine, a combination of glucose and the amino acid glutamine, furnishes the basic building blocks of mucopolysac-charides such as glucosaminoglycans (GAGs) and proteoglycans that form the framework of bones, cartilage, nails, hair and skin. Increased amounts of glucosamine stimulate the activity of specialized cells called chondrocytes. These cells then build a framework of bone and cartilage with mucopolysaccharides.

Chondroitin sulfates act as bait, attracting fluid into the weblike cartilage that covers the bones of the joint. The fluid attracted into the cartilage provides shock absorption for surrounding bones and supplies nutrients to the cartilage, thus sup-porting its regeneration and growth. Joint cartilage does not possess a blood supply, so its nutritional needs must be met by the fluid surrounding the joint.

Researchers at Boston University Medical Center examined the knees of 556 patients during a two-year period.1 Those patients who showed ptogressive knee darnage due to osteoarthritis also exhibited lower levels of vitamin D."A vitamin D deficiency could impair the body's ability to repair the damage that arthritis causes in both bone and cartilage," says David Felson1 a principal investigator in the study.

I Antioxidants: The antioxidant vitamins A1 C and E and the mineral selenium are regularly touted as free radical scavengers. Free radicals are unstable molecules with missing or extra electrons that attack tissue such as cartilage or joint tissue in search of stabilizing electrons. The antioxidants scavenge or stabilize free radicals and, if present in sufficient quantities, can help prevent free radical-induced tissue damage and resulting inflammation.

A high intake of antioxidants, especially vitamin C, may reduce the risk of cartilage loss and slow the progression of osteoarthritis. Participants in the Framingham Osteoarthritis Cohort Study who took higher than average amounts of vitamin C had a threefold decrease in the risk of osteoarthritis.2 Vitamin C, like vitamin E, also protects and enhances cartilage formation. Guinea pigs with experimental osteoarthritis given 150 mg daily of vitamin C demonstrated significantly less cartilage erosion than animals given only 2 mg vitamin C.

Boron, though not an antioxidant, does prevent cells from releasing free radicals. Epidemiologic studies show that people in countries with low amounts of boron in the soil often have osteoarthritis.4 Conversely, boron supplementation may encourage cartilage repair and synthesis. One open trial demonstrated that boron supplementation of 6-9 mg daily caused symptom remission in 90 percent of arthritis patients studied including people with osteoarthritis, rheumatoid arthritis and juvenile arthritis.5 Although glucosamine is common in most foods, supplemental sources of glucosamine are just as useflil. Four forms of glucosamine are available as supplements-hydrochloride, hydroiodide, n-acetyl and sulfate but glucosamine sulfate has been studied the most. Chondroitins are available in animal tissues such as meat gristle. Supplemental chondroitin sulfates are absorbed by the body but to a lesser extent than glucosamine sulfate because of their large size. They do not produce toxic side effects in high doses.

Enzymes: Bromelain is a mainstay for treating muscle injuries, but its anti-inflammatory actions may also ease arthrit-ic pain. The proteolytic enzymes obtained from the stem of the pineapple plant (Ananas comostts) break down scar tissue, decrease edema and block inflammatory mediators.10 In addition, when antioxidant enzyme superoxide dismutase (SOD) was injected into arthritic joints, it also had significant therapeutic effects11. Oral doses are less likely to work.

Why Natural May Be Better

The process that contributes to osteoarthritis and results in chronic pain for millions of people ironically has the potential to be stopped and, in many cases, reversed. Researchers following the natural course of osteoarthritis found that 14 of 31 people with untreated osteoarthritic hips experienced complete recovery.12 These and other similar results suggest that medical intervention may actually speed the dis-ease along. Aspirin and other nonsteroidal anti-inflammatory drugs such as ibuprofen can not only trigger well-known side effects including gastrointestinal upset, headaches and dizziness, but studies show that they also inhibit cartilage synthesis and speed its destruction.13 The very drugs designed to alleviate osteoarthritic pain may actually contribute to the diseas~the drawback to treating symptoms and not the cause.